Pulmonary Flashcards
MC pathogen and treatment for CAP (adult and pediatric)
Step. Pneumo *rusty (blood-tinged sputum)
*Give macrolide of doxycycline, amoxicillin for pediatrics
Cor pulmonale
Longstanding pulmonary HTN resulting in RVH, right atria enlargement, R sides heart failure, cyanosis, peripheral edema
*high risk in chronic bronchitis, a fib, and multifocal atrial tachy
What is the most common cause of transudative pleural effusions?
Congestive heart failure
What is the 2nd most common cause of typical CAP?
H. Flu (green sputum)
*seen in patients with underlying pulmonary dz
What is the most common cause of atypical, walking pneumonia?
Mycoplasma pneumonia
- seen in young patients
- bullous myringitis
In what population will klebsiella pneumonia cause severe illness?
Alcoholics , aspirations
*current jelly sputum , cavitation lesions
MC viral pneumonia cause in infants/young kids
RSV and parainfluenza
Typical pneumonia presentation
Fever, productive cough, Pluto this chest pain, rigors
-signs on consolidation such as increased fremitus, egophany, takes
Typical pneumonia organisms
S. Pneumonia
H. Flu
Klebsiella pneumonia
S. Aureus
Atypical pneumonia pathogens
Mycoplasma pneumonia (MC)
Chlamydia pneumonia
Legionella pnumophila
Virus
Atypical pneumonia presentation
Slight fever, dry cough, myalgias, sore throat, headache
- may ha e normal CXR
CAP inpatient treatment
Beta-Lactam + macrolide
Ceftriaxone+ azythromycin
Add on treatment if legionella pneumonia suspected
Levofloxacin
Add on treatment if PCP suspected
Bacterium + corticosteroids
Homan’s Sign
Calf pain with dorsiflexion, DVT
Classic triad of pulmonary embolus
1) dyspnea
2) pleuritic chest pain
3) hemoptysis
Sarcoidosis epidemiology
20-40y/o females of AA or Northern European decent
Sarcoidosis pathophysiology
Exaggerated T cell response of unknown origin causing inflammatory non caseating granulomas
PFT findings in RESTRICTIVE lung dz
- normal FEV1
- LOW lung volume
Skin manifestations of sarcoidosis
1) erythema nodosum
2) lupus Pernio*PATHOPNEMONIC
(Violet raised discoloration of nose, ear, cheeks-resembles frostbite)
Lab studies found in sarcoidosis
1) High ACE levels: secreted by the granulomas
2) hypercalciuria
3) eosinophilia
4) cutaneous anergy: diminished skin test reactivity
Classic presentation of Sarcoidosis
Respiratory s/s, blurred vision, erythema nodosum
PFT levels in OBSTRUCTIVE lung dz
LARGE lung volumes
-LOW FEV1
Lofgren’s syndrome/triad
1) erythema nodosum
2) hilarious lymphadenopathy
3) polyarthralgias/fever
*common sarcoidosis presentation
CXR and bx findings of pulmonary fibrosis
- diffuse reticular opacities
- honeycombing
- Ground glass opacities
*honeycombing on bx
Silicosis
Egg shell calcifications of the upper lung fields
Coal workers pneumoconiosis CXR
small upper lobe modules with hyperinflation
*more an obstructive lung presentation
Berylliosis
Beryllium found in aerospace equipment
Can be managed with steroids
Byssinosis
Due to cotton exposure
-“Monday fever” : worse at the beginning of the week
Asbestos
Found in construction yards. Does not present till 15/20 years later.
- pleural plaques and honeycombing in the lower lung fields
- high risk of bronchogenic carcinoma and malignant melanoma
Physics exam findings in a pleural effusion
DECREASED tactile fremitus,
DECREASED breath sounds
DULLNESS to percussion
Tension pneumothorax Physical exam
JVP, pulsus paradoxus, hypotension
What defines a pulmonary module?
Lesion <3 cm
Etiologies of pulmonary nodules
1) INFECTION: tb MC
2) TUMOR
3) INFLAMMATION: RA, sarcoidosis
4) MEDIASTINAL TUMOR: thymoma MC
What does a bronchial carcinoid tumor look like on broncoscopy
Pink to purple well vascularized central tumor
Management of carcinoid tumor
1) surgical removal
2) octreotide
What is the MC cause of cancer deaths ?
Bronchiogenic carcinoma
Where does lung cancer MET to?
Brain bone Liver Lymph Adrenals
3 types on non small cell carcinoma
1) adenocarcinoma
2) squamous call
3) large cell
Key features to non- small cell adenocarcinoma
- MC type in nonsmokers and females
- PERIPHERAL
- presents with gynecomastia
- surgical resection
Key features to squamous cell carcinoma
- CENTRALLY located
- Cavitary lesions
- hyperCalcemia
- pancoast syndrome (tumor at the superior sulcus causing :
1) shoulder pain
2) horners syndrome
3) atrophy of hand muscles
Small cell carcinoma key features
1) SVC syndrome: dilated neck veins, facial plethora, prominent chest veins
2) SIADH(hyponatrimia)
3) Cushing syndrome
4) lambert Eaton syndrome (like MG but weakness improves with use)
* chemo is TOC no surgery
At what pressure is pulmonary HTN diagnosed?
> 25mmHg
Diagnosis and management of primary pulmonary hypertension
Right sided heart cath =GOLD standard
- give calcium channel blockers *
Anticholinergics used in COPD
Tiotropium (spiriva)
Ipratropium (Atrovent)
**these are preferred over SABA (albuterol). combo therapy also proves to better than monotherapy.
What antibiotic would you give a COPD exacerbation patient as antibiotic prophylaxis due to it anti-inflammatory properties in the lung?
Azithromycin
Large pericardial effusions (>250 ml) have what classic appearance on chest radiograph?
Large “water-bottle” cardiac silhouette with epicardial halo.
What is a characteristic chest x-ray in a TB patient ?
CASEATING granulomas
- reactivation typically occurs in the upper lobes
- Primary typically occurs in the middle/upper lobes
Two extra-pulmonary manifesttions associated with TB?
1) Potts dz (vertebral)
2) Scrofula (lymph nodes)
TB treatment
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol
* **continue for 6 months
Major side effects of Rifampin
thrombocytopenia, orange colored secretions
Major side effects of Isonizaid
peripheral neuropathy, Hepatitis
Major side effects of Pyrazinamide
potosensitivity rash, hyperuricemia, hepatitis
Major side effects of Ethambutol
Optic neuritis, peripheral neuropathy
A high V/Q ratio is found in what dz?
emphasema; air is able to get into the lungs to problem (ventilation), but the alveoli are collapsed causing no perfusion
A low V/Q ratio is found in what dz?
Chronic bronchitis; there is little ventilation due to the obstruction with good perfusion of the air that does make it there.
Short Acting Beta Agonists used in asthma
albuterol & terbutaline
2nd line therapy after SABA in a patient with mild persistent asthma
SABA + low dose ICS
- Beclamethasone
- flunisolide
- triamcinolone
Long Acting Beta Agonists used in COPD
Salmetorol
Anticholinergics used in COPD/Asthma
Ipratropium (atrovent)
Rapid relief drugs for COPD/Asthma exacerbation
1) SABA=albuterol ** best in Asthma
2) anticholinergics= atrovent ***best in COPD
Steps to the treatment of primary pulmonary hypertension
1) is the pulmonary vasculature vasoreactive??
- If YES, then CCB are the treatment of choice
- If NO, then prostacyclin, PDE-5, vasodilators
What is the treatment for a latent TB infection
INH+PRYRIDOXINE (it B6) for 9 months!! (12 months if HIV+)
What do the pulmonary capillary wedge pressures look like in ARDS vs. cariogenic pulmonary edema
ARDS= normal <18 cardiogenic = HIGH
